Your Role in Infection Control

FIRST PERSON

On October 1, the Center for Medicare and Medicaid Services (CMS) implemented restrictions on payments for hospital-acquired infections (HAIs) or hospital-acquired conditions (HACs). State and private insurance payers for medical procedures will likely duplicate these restrictions. CMS is encouraging state agencies to follow its lead when reimbursing hospitals under Medicaid.

CMS says it does not cover circumstances caused by carelessness. For example, situations such as leaving sponges or surgical implements in the patient, using incompatible blood and blood fractions, or performing the wrong procedure (or the correct procedure on the wrong body part or on the wrong patient) are no longer reimbursable. Moreover, surgical-site infections involving catheters used in treatment of urinary tract infections, bloodstream infections, and mediastinitis following coronary bypass surgery are not covered. Secondary infections following bariatric obesity treatment, orthopedic surgery and deep vein thrombosis, and pulmonary embolism following total knee and hip replacement are also on the list of conditions not to be covered.

In addition, there are new requirements for monitoring a patient's blood sugar levels to prevent hypoglycemia and diabetic keto­acidosis. In CMS's FY 2010, restrictions on payments are likely to be extended to outpatient procedures.

CMS has also considered other conditions for inclusion, such as infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, but has for the time being held off in anticipation of public comments.

Hospitals are required to report incidence of HAIs and to report improvements in reducing such occurrences, or they face losing some of their reimbursement. More conditions will be removed from reimbursement in the future, and the agency has set April 30, 2009, as the target date to publish its next list of nonreimbursable occurrences.

These restrictions should lead to an increased use of screening procedures against common HAIs. The goal is to ensure that conditions predate the patient's entry to the hospital or treatment center. Use of diagnostic devices should increase, and CMS has published a list of 42 recommended screening procedures. Additional training of hospital personnel is also required to minimize the likelihood and incidence of HACs. The Association of Professionals in Infection Control and Engineering has instituted conferences and training programs to educate nurses and physicians in charge of patient safety in the latest technologies for infection control and for minimizing HAIs and HACs.

Silver Linings

A benefit to increased use of infection control procedures is the development of technologies for disease prevention. The copper industry has obtained sanction from the Environmental Protection Agency (EPA) to classify the metal and some of its alloys as pesticides, thereby enabling users of these materials to make claims in their literature about controlling pathogenic organisms. The Silver Institute is also considering applying to EPA for a similar designation for commercial silver-based biocide preparations. For example, needles and other sharps could be designed with a small amount of silver in the lubrication coating to make the surface less hospitable to pathogenic microorganisms.

The increased care taken at hospitals should result in greater comfort and less harm to patients. It should also bring down the overall costs of healthcare. For device and diagnostic kit manufacturers, the focus must be on creating products that enable rapid screening for various medical conditions. Additional opportunities will arise from products that provide safe and effective treatment of medical conditions at low cost. Products that are less hospitable to ambient pathogenic bacteria, fungi, and other organisms are in high demand. In addition, products should monitor and maintain stable patient temperatures, fluid levels, and other conditions, such as blood sugar levels.

Hospital administration and personnel in charge of infection control are aware of these developments and are ready to comply with the CMS directives. But companies should inform customers of products that help them comply with CMS goals.

The medical device and diagnostic industry should view these developments as a major opportunity to develop products that can help to deliver more cost-effective healthcare with added safety for patients and healthcare personnel.

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